Ireland Patrick A, Borruso Luca, Spencer Sascha K R, Rosen Richard, Rosen Robert
Prince of Wales Hospital, Randwick, NSW, Australia.
University of New South Wales, Randwick, NSW, Australia.
Int J Dermatol. 2024 Apr;63(4):413-421. doi: 10.1111/ijd.16916. Epub 2023 Nov 27.
Many patients undergoing cutaneous surgery are prescribed at least one anticoagulant or antiplatelet agent. With the recent emergence of direct oral anticoagulants (DOACs), there is a deficit of knowledge regarding optimal perioperative management. This review aims to evaluate the evidence and risk surrounding management of DOACs in patients undergoing skin surgeries.
Systematic review of EMBASE, Scopus, and PubMed, with inclusion of studies that detailed perioperative management of DOACs in those undergoing skin surgery. Primary outcome measures were perioperative hemorrhagic and thromboembolic complications.
Seven thousand seven hundred and forty-one abstracts were identified, with 13 articles meeting inclusion criteria. Two studies investigated complication risk associated with DOAC continuation in skin surgery and found an average rate of hemorrhagic complications of 1.74%. Two studies evaluated complications associated with DOAC cessation prior to skin surgery, with a pooled thromboembolic complication rate of 0.15%. Articles comparing continuation and cessation discovered no decreased risk of bleeding with DOAC cessation prior to surgery (P = 0.93). Seven of the 13 articles compared complications in a control vs a DOAC group undergoing cutaneous procedures. Evidence was conflicting but may have suggested a small increase in bleeding risk in those on DOAC therapy.
Optimal management of anticoagulants perioperatively is difficult because of conflicting information, complicated by advent of novel agents. Risk of hemorrhagic complications with both continuation and interruption of DOAC therapy was low. Perioperative DOAC management can be guided by procedural bleeding and patient clotting risk and can often be continued in minor dermatologic procedures.
许多接受皮肤外科手术的患者会被开具至少一种抗凝剂或抗血小板药物。随着直接口服抗凝剂（DOACs）的近期出现，关于最佳围手术期管理的知识存在不足。本综述旨在评估接受皮肤手术患者中DOACs管理的证据和风险。
对EMBASE、Scopus和PubMed进行系统综述，纳入详细描述接受皮肤手术患者DOACs围手术期管理的研究。主要结局指标为围手术期出血和血栓栓塞并发症。
共识别出7741篇摘要，13篇文章符合纳入标准。两项研究调查了皮肤手术中继续使用DOACs相关的并发症风险，发现出血并发症的平均发生率为1.74%。两项研究评估了皮肤手术前停用DOACs相关的并发症，汇总血栓栓塞并发症发生率为0.15%。比较继续使用和停用DOACs的文章发现，术前停用DOACs并未降低出血风险（P = 0.93）。13篇文章中的7篇比较了接受皮肤手术的对照组与DOAC组的并发症。证据相互矛盾，但可能表明接受DOAC治疗的患者出血风险略有增加。
由于信息相互矛盾，加上新型药物的出现，围手术期抗凝剂的最佳管理很困难。DOAC治疗继续和中断时出血并发症的风险都很低。围手术期DOAC管理可根据手术出血情况和患者凝血风险进行指导，在小型皮肤科手术中通常可以继续使用。
